Diabetes is a chronic illness that requires continuing medical care and education to prevent acute complications and to reduce the risk of chronic complications.

The historical development of targets for the management of diabetes

• 1- Prolongation of life (up to 1921)
• 2- Treatment of acute symptoms (1921 onwards)
• 3- Prevention of acute complications (1921 onwards)
• 4- Control of blood glucose levels (1960s onwards)
• 5- Prevention of microvascular complications (1970s onwards)
• 6- Prevention of macrovascular complications (1970s onwards)
• 7- Normal duration and quality of life (1976 onwards)
• 8- Prevention of the disease, treatment satisfaction and patient self management (1990s onwards)

Standards of diabetes care will provide:

1-Physicians: With means to set the treatment goals, to assess the quality of diabetes treatment provided , to identify areas where more attention or self-management training is needed, and to define timely and necessary referral patterns to appropriate specialists

2-Diabetics: With means to assess the quality of medical care they receive, to develop expectations for their role in the medical treatment and to compare their treatment outcomes to the standard goals

Audit in diabetes care

It is suggested that if an optimum service to be provided on the continuing basis then continuing audit of activities is necessary.

Audit of diabetes care reveals successes and failures of the service and helps in resource planning

Audit of diabetes care are

1-Process audit

2-Outcome audit

Process Audit

Concerned with structure of the procedure carried Clinical process Investigations Decisions Referral Done annually

Outcome Audit

Makes the assumption that protocols of care, if followed, will achieve the desired results. Looks for the end results on the patient health status.

Difficulties in Diabetes:

• 1- Chronic nature of the disease with remote complications
• 2- Asymptomatic complications
• 3- lack of specific measurable parameters except for the glucose, lipid, albumin, HbA1c.

Examples of measures of diabetes process and outcome audit

1-Process

• Eye screening
• Foot care
• Dietary advice
• Educational courses
• Medication given

2-Outcome

• Health status
• Glycohemoglobin
• Microalbumin
• Blood pressure
• Lipid profile
• Weight
• Retinopathy
• Educational level Health outcome
• Visual acuity impairment
• Foot ulceration
• Amputation
• Coronary or cerebrovascular disease
• Renal failure
• Erectile impotence
• Quality of life status

Facilities for audit

• Retrospective collection of data from unstructured diabetes notes
• Prospective collection of data onto forms then entered onto computer
• Computer collection of data from its sources

Characteristics of valuable computer program

• Easy feeding of data
• Easily updated and restructured
• Copes with the experts need and cover all the processes of care
• Cover all the clinical and investigatory activities
• Helps in decision making Includes statistical facilities
• Capable of building reports
• Work through individual computer or through a network

Rotation through a diabetes center (Covered by a Computer Program)

• Reception station
• Diabetes nurse
• Diabetologist Regular review & Annual review
• Dietician
• Laboratory
• Other specialities when needed
• Ophthalmologist
• Chiropodist
• Cardiologist
• Nephrologist
• Gy./Obs.
• Psychologist
• Vascular surgeon
• Paediatrician
• Diabetes educator